The NEJM’s breaks the hidden truths about cardiopulmonary bypass in a beating heart. The irony in medical science is , trend setting land mark articles usually arrive very late . . . to disappoint all those patients who got the wrong treatment ! Off pump by pass is definitely one among them . . .

The major reason for off pump CABG’s s poor showing is

The surgeon’s conflict in defining what is successful CABG .The success of CABG is in relief of symptoms & providing good bypass graft with long term patency .It is not in less thoracic trauma or in a quick hospital discharge !

The second major reason is denial of the fact that off pump CABG is indeed inferior and hence no course correction was attempted ! ( And now that it has become a hard evidence we expect some changes . It required almost 10 years for our cardiology community to recognise this .)

Lesion access and difficulty in mobilizing LIMA .Many times the the point of anastomoses is preselected by the accessibility and technical issues rather than lesion guided approach .This often happens than we imagine , and this could be a very bad advertisement for off pump CABG